The physician's alternative career transition model: a stepwise approach.

As a result of this era of intense focus on marketplace reform, increased governmental regulation of medical practice, the corporatization of health care, and an increasingly litigious society, some physicians are finding themselves in an unfamiliar--and often unfriendly-environment.[1,2] This has, in turn, stimulated a reassessment of career planning options for some physicians. In the past, it was not uncommon for physicians seeking alternative career options to pursue medical management. These physician executives sought to utilize their medical backgrounds in ways that were administrative extensions of traditional clinical practice.[3-7] Recent and anticipated changes in the clinical environment have made these options more appealing for some. However, these changes have also created unique opportunities beyond the traditional arenas of clinical practice and medical management for others to leverage their medical degrees and experiences in the business world. This paper will present three case reports of "physician-businesspersons" who have successfully pursued medically related business career options, each following different motivations at various stages of their medical careers.

Case Report 1

SBJ is a 33-year-old male medical school graduate who decided, after completing his third-year clinical rotations, that he was more interested in a medically related business career than in a clinical one. After passing his boards and receiving his license to practice medicine, he attended business school, earning an MBA in health care management and marketing. During this time, he also worked as a health care management consultant for tertiary cafe hospitals and large physician group practices. After receiving his MBA, he joined a large, international pharmaceutical company in its worldwide business development department. His subsequent work at this same company has included positions in medical services, medical research, medical marketing, product management, managed care, and pharmacoeconomics. He maintains an adjunct professorship at his business school alma mater.

Case Report 2

NLS is a 4 1 -year old female with board eligibility in pediatrics and board certification in otolaryngology. While serving as an attending in an academic setting and maintaining the responsibilities of a single parent, she sought career growth and diversity by performing health cafe reports for a local television station. After she honed her broadcasting skills for four years, her segments were picked up by national television networks and she pursued the opportunity to cohost a popular national morning news show. Her television reporting, writing, and producing soon became a major part of her occupation. She has now become a recognized national television celebrity, maintains an associate clinical professorship at a medical school, and continues to see patients five days per week.

Case Report 3

SBS is a 70-year-old male general surgeon, ready to retire from the rigors of a successful practice he built over 30 years. Despite being an avid club golfer, this energetic senior is not interested in complete "retirement." Throughout his career, he maintained an interest in various health care-related businesses; in preparation for his clinical retirement, he targeted his many contacts in this arena in order to identify a suitable job opportunity. After considering opportunities with several companies, he joined a health care medical information systems start-up company as its medical director. This will leverage his medical expertise and his health care contacts in both a business development and a sales capacity. He continues to maintain positions on several committees at his local medical and nursing schools.

These three physicians represent an increasing number of physician executives who have ventured beyond the realm of traditional clinical medicine and medical management to leverage their medical knowledge and clinical experience in the business world. As demonstrated by these examples, the types of physicians who gravitate toward business are diverse and make their career transitions for numerous reasons.[8,9] Some, as typified by Case Report 1, may have special interests or talents that they choose to pursue. Others, exemplified by Case Report 2, may become dissatisfied with clinical practice for one or several of a host of reasons and are actively or passively seeking an alternative. Some older physicians, as demonstrated by Case Report 3, may want to retire from the demands of clinical practice but may not yet be ready to retire from the work force altogether.

These three physicians have entered the business arena in the fields of pharmaceuticals, media, and entrepreneurial ventures. However, these are only three of the many possible fields for such physician executives. Other business areas in which interested physicians can leverage their medical backgrounds include, but are not limited to, health care consulting, medical writing /publishing, medical education, medical advertising, public relations, investment banking, venture capital, securities analysis, insurance, information technology, and managed care ventures.[8]

Character traits of successful physician executives are numerous and varied. A common denominator is the ability to make effective transitions from the medical profession to their chosen business careers. Based upon informal interviews with hundreds of physicians who have made successful transitions into the business arena, we have developed the Physician Alternative Career Transition (PACT) model, which is built on four critical steps to making successful transitions: an internal self-evaluation process; an external environmental evaluation process; seeking the best "career match"; and, finally, securing the career match.[10]

Internal Evaluation

The first critical step to success is a systematic, thorough, internal self-evaluation. The internal evaluation process has three major components: the personal needs assessment, the personal interests assessment, and the personal skills assessment. These represent three basic questions physicians rarely ask themselves:

* What do I need?

* What do I really like?

* What am I really good at (besides medicine)?

To answer the first question, both tangible and intangible factors must be considered. While these factors may seem simplistic, it is often difficult for physicians, who have been trained to focus on the needs of others, to consider their own needs, particularly as these have typically been put aside, often at tremendous self- and family sacrifice. While issues such as compensation and geographic location seem straightforward, they can become complex once such issues as life-style and family concerns are addressed.

There are numerous intangible factors to consider. However, there are three common issues that physicians usually confront.[11,12] A major challenge for most physicians who make these transitions is the issue of going from an independent role as a clinician to a subordinate employee position, especially if reporting to a nonphysician boss. Second, going from command and control in a clinical setting, where "doctors' orders" rule, to a consensus-oriented decision-making process in business can often be difficult for many physicians. Physicians are generally very comfortable making independent decisions. In business settings, the decision-making process can often move relatively slowly; this can be frustrating. A third consideration is maintaining one's self-esteem while moving from one's established, certified competence in medicine to relative naivete and inexperience in business. The most important question for physicians to ask themselves related to this realm is "Why am I looking beyond clinical medicine"? Answering this question not only is central to the internal evaluation process, but also is essential for using the PACT model successfully.

While the second question also seems basic, many physicians have difficulty answering it thoroughly. For example, throughout residency training, and even in the early years of practice, physicians generally put former personal interests, skills, and hobbies aside, often to the point where those neglected attributes are forgotten. These are important experiences to resurrect in order to focus on special skills and interests. A particularly important question for physicians to consider in this category is the extent to which to maintain a connection to clinical or academic medicine. Various combinations of part-time practice and part-time business activities are feasible, as are limited connections such as maintaining adjunct clinical or academic faculty responsibilities. Maintaining this connection through active participation in continuing medical education programs, medical organizations, and specialty societies is another option, as is pursuing a business opportunity related to scientific or medical research. The aim of this question is to determine ultimately what combination of business opportunity and ancillary activities will produce the most professional and personal satisfaction. It is important to recognize that the percentages of time dedicated to each component can--and probably will--change over time.

The final portion of the self-evaluation process is the personal skills assessment. It is important to evaluate thoroughly one's existing skills, emphasizing those that are strengths and are transferable. For example, most physicians have a variety of general skills that are considered assets in any business environment. These include strong interpersonal skills, analytical skills, communication skills, problem-solving skills, decision-making capabilities, and a highly developed intellect. While physicians are not generally reputed to have strong business skills, physicians who have been in private practice or have run academic or managed care departments may have a reasonable amount of management experience, some financial skills, some computer skills, and an increasing awareness of marketing. Clearly, the most important aspect of the personal skills assessment is an individual physician's ability to successfully adapt these skills from medical to business applications.

External Evaluation

The external evaluation process is more difficult than the internal evaluation process in one key respect: by definition, the self-evaluation process is self-originated and self-limited. In performing the external evaluation process, however, many physicians report not knowing where to begin, whom to consult, how to proceed, or how to know when each relevant variable has been thoroughly considered. Furthermore, the gold standard of medical information-gathering, the literature search, typically generates limited helpful information.

The external evaluation process has three components. The first is information gathering, a process with two main objectives: to identify potential appropriate opportunities and to identify people or contacts who may help to secure those opportunities or to obtain further information about them. This component highlights the principal difference in this process for physicians relative to nonphysicians. While nonphysicians can search ads and other published information to identify available opportunities, physicians often need to gather information about opportunities that may not yet exist, that may not be targeting a physician candidate, or that may only be disseminated through informal communication channels. Furthermore, the best opportunities for physicians in business may be those that an individual physician develops or creates, often working with an established company to do so.

There are several effective ways for motivated physicians to collect information about potential opportunities or interested employers. The first step should be reviewing the appropriate literature. This includes literature searches of relevant medical or business publications, focusing on trade journals in the industry of interest. One way to obtain information about specific companies is to contact their human resources or public relations departments directly to request their annual reports or company brochures. Perhaps the best method for information gathering is through strategic networking, communicating three key issues to appropriate contacts: one's interest--or possible interest--in considering an opportunity in business; one's specific needs, interests, and skills; and finally, recommendations for referrals to other appropriate contacts. In using this approach, it is important to balance one's need for confidentiality with the need to gather information from others who may help to achieve future career goals.

This networking communications strategy lays the groundwork for the second information gathering step: informational interviewing. This involves meeting with a businessperson, perhaps in a health-care-related field, to obtain "soft information" that is only available through personal contact. This includes subjective impressions of working in an industry as well as advice regarding recommended industries, companies, and positions to pursue. It must be made clear that this is not a job interview per se and that the person providing the informational interview is doing so as a favor.

A final option for gathering information about potential opportunities is through executive or career search consultants. The advantage of this approach is that certain consultants may be familiar with the more conventional opportunities available for physicians in business, such as with a diversity of pharmaceutical or health care consulting companies. The primary disadvantage of this approach is that these consultants are usually not well informed about nonconventional opportunities that might be more appealing to a physician businessperson. Furthermore, their primary motivation is to hire individuals for specific positions that they have been (or will be) commissioned to fill. A physician seeking a successful business match must be cautious to maintain control of the opportunity seeking process.

Making the Business Match

Once several appealing opportunities have been identified, the next concern is ensuring an appropriate match. There are a number of important factors to consider in doing so:

* Acquiring the necessary skills. Appropriate training for a specific position may range from a one-day computer seminar to completing an MBA. It is important to distinguish between skills that must be acquired prior to securing a position and those that may be developed once the position has been secured. Because physicians tend to be focused on the need for specified training and certification prior to being eligible for a position, some physicians seeking a transition to a business career assume that earning a business degree is a prerequisite for seeking these opportunities. This false assumption underscores the importance of the information-gathering process.

* Optimal self-positioning. Because the business world generally thinks in terms of packaging, the successful physician executive must be oriented toward presenting him- or herself not only as the desired "package," but also as one with additional, valuable assets.

* Effective resume writing. While the business resume is comparable to the medical curriculum vitae in importance, it is a very different document. The resume should be prepared as a personal promotional summary brochure that can be customized for the particular position being considered. Selected work experiences, educational background, and other listed achievements must exemplify how these experiences can add value to the targeted company or position.

* Seeking the "business match." The interview process must be viewed as a collaborative one in which the candidate and the company begin working together to develop a win-win situation; it is in the best interests of both parties to secure the ideal business match.

Securing the Business Match

While many candidates consider a search completed once an appealing opportunity has been identified and offered, the most successful candidates will make additional efforts to guarantee their eventual success in their new opportunity. There are six commonly overlooked keys to securing the ideal business match:

* Overcome the myth of the physician as a poor businessperson. This prevalent prejudice among many business people must be confronted directly. To counteract this gross generalization, it is important to highlight one's own business skills and interests, team orientation, and commitment to making a successful transition.

* Prepare an effective response to the question, "Why are you leaving medicine?" This question was referred to above as an essential component of the internal needs assessment; at that point, it was sufficient to resolve this question for oneself At this juncture, it is important to reformulate that assessment into an appropriate response directed to your relevant target audience. Any potential business partner will inquire about what motivated this career transition. As with patient interview situations, it is essential to evaluate the "hidden agenda" behind this question prior to responding. Usually, this question really addresses whether or not the physician in transition is truly interested in business and new opportunities, or whether this is simply an "escape" from an increasingly challenging clinical environment. Ideally, these fears and apprehensions should be allayed with a capable, confident, and committed positioning: "I am not 'running away' from medicine, but `running toward' this new business opportunity."

* Be flexible and creative. As discussed earlier, many business opportunities for physicians--usually the most appealing and rewarding ones--have yet to be developed. If a position or opportunity under consideration does not seem the best fit, it should be redesigned to benefit both parties. In business, initiative, innovation, and creativity are highly valued qualities.

* Confirm the company's commitment In hiring physicians, companies usually need to make a far more substantial commitment than with other employees, particularly with regard to compensation and training. The company should prepare--and the physician should request--a written job description with objectives; expectations on both parts should be clear and explicit. Equally important is the company's proposal for facilitating the physician's transition into its industry in general and its corporate culture in particular.

* Conduct effective negotiations. When most physicians hear the term "negotiating," they equate this with salary. In business, however, the total compensation package is usually much more relevant. Such a package may include annual bonuses, stock options, health care benefits, company car, and professional expenses (licensure renewal, meeting registrations, journal subscriptions, etc. . Examples of other factors that can be negotiated include maintaining a part-time faculty position; weekly time reserved for professional activities (such as patient care, teaching, or research); amount of vacation time; computer equipment; and support staff. Regardless of your relationship with the company or the individual representing the company, each of these points should be negotiated up front and documented in a letter of agreement.

* Discuss career development and planning. Most important, work with the company from the outset to plan subsequent career development, not only for the position under discussion, but also for future advancement and growth. Ask how the company envisions a specific career track; this is something that should be mutually agreeable or further discussed. As in medicine, the individual physician is responsible for his or her own career development; unlike in medicine, there are no standard training or qualification paths.

Conclusion

The practice of clinical medicine still remains the most rewarding profession for most physicians. However, for physicians who are talented, interested, and committed to making a transition into business, there are unlimited opportunities to leverage their medical degrees and experiences. Health care in the United States is on the threshold of what many physicians consider to be disconcerting change. However, other physicians may perceive these times as a unique opportunity to explore alternative career options and to find unusual professional challenges on the cutting edge of the art and science of medicine and business, for the benefit of themselves, their families, and the broader spectrum of patients at large.

RELATED ARTICLE: Oklahoma Physicians to Form Statewide HMO 

In 1994, the Oklahoma State Medical Association commissioned a study to determine the feasibility of a statewide, physician-owned and -operated IPA-HMO. The results were so overwhelmingly positive that the group has filed with the state to register its HMO, Proklahoma, and its IPA, Oklahoma Physicians Network.

When approval is received, the physician group will begin selling shares, which will cost $3,000 during the first 30 days of the offering, $3,500 during the next 30 days, and $4,000 thereafter. Prospectuses will be sent to 4,500 MDs and DOs throughout the state. A buy-in by at least, 2,000 doctors is needed to raise the capital necessary to launch the venture.

An IPA board will be established to determine a fee schedule dor services, and the HMO will work with hospitals throughout Oklahoma to garner good rates for members.

Currently, managed care penetration is only about 8 percent in Oklahoma, but a large increase looms. The statewide IPA-HMO is viewed by physicians in Oklahoma as a way to control their destinies in an era of fading autonomy and to provide higher quality health care in a price-conscious world.

References

[1] Reames, h., and Dunstone, D. "Professional Dissatisfaction of Physicians." Archives of Internal Medicine 149(9):1951-6, Sept. 1989. [2.] Steptoe, S. "Dispirited Doctors: Hassles and Red Tape Destroy Joy of the Job for Many Physicians." Wall Street Journal, April 10, 1987, pp. 1, 12. [3.] Hillman, A., and others. "Managing the Medical Industrial Complex." New England Journal of Medicine 315(8):511-3, Aug. 1986. [4.] Page, L. "From Lab Coat to Suit." American Medical News, April 10, 1987, pp. 14-15. [5.] Doyne, M. "Physicians as Managers." Healthcare Forum 30(5):11-3, Sept.-Oct. 1987. [6.] Fulton, A., and Longshore, G. "The Physician-Executive: A New Breed of Manager. " Hospital Physician, Jan. 1988, pp. 41-8. [7.] Feldman, M. "Physician Executives: Can They Manage Both Worlds?" Minnesota Medicine 73(2):26-29,31, Feb. 1990. [8.] Balagot, M. Leaving the Bedside: the Search for a Nonmedical Career. Chicago, Ill.: American Medical Association, 1992. [9.] Morain, C. Is There Life after Private Practice?" American Medical News, Aug. 1992, pp. 25-6. [10.] Bernard, S., and Moore, D. "Leveraging Your Medical Degree in the Business World." Advances in Medical Management. Tampa, Fla.: American College of Physician Executives, 1991, pp. 109-12. [11. McCall, M., and Clair, J. "In Transit from Physician to Manager--Part I." Physician Executive 18(2):3-9, March-April 1992. [12.] McCall, M., and Clair, J. "In Transit from Physician to Manager--Part II. Physician Executive 18(3):15-9, May-June 1992.

Stan Bernard, MD, MBA, is Associate Principle, Health Care Industry, for EDS Management Consulting Services. He also serves as the MD-MBA Career Counselor and as Associate Lecturer in Pharmaceutical Management at the Wharton School of Business. Donnica L. Moore, MD, is Associate Director, Professional Relations, at Sandoz Pharmaceuticals Corporation and Vice President, Communications, American Medical Women's Association.